Hands-on bowel techniques

Authors: SCIRE Community Team | Reviewer: Bonnie Nybo | Published: 20 March 2018 | Updated: 23 October 2024

Digital stimulation is a common spastic bowel emptying technique.¹¹

Most people will need to use “hands-on” (manual) techniques to empty the bowel. Some people may need assistance from a care provider to use these techniques. They are usually done while sitting on a toilet or commode or while lying on your left side with the knees bent on an underpad.

People with spastic bowel typically use a technique called digital stimulation, digital rectal stimulation, or rectal touch to empty the bowel. Digital stimulation is a technique in which a gloved and lubricated finger (known in anatomy as a “digit”) is gently inserted into the anus and moved in circular motions along the walls of the rectum. This triggers a reflex that causes rectal contractions and loosening of the anal sphincters to allow emptying.

Digital stimulation is one of the most common techniques used for bowel emptying after SCI, however very little research has been done to determine if it is effective.

People with injuries at T6 and above may trigger

autonomic dysreflexia

when performing digital stimulation and other bowel techniques. Keep an eye out for signs including sweating, headache, heart rate changes, goose bumps and increasing muscle spasms, and stop any techniques right away. Autonomic dysreflexia can also be triggered by bowel problems such as constipation or hemorrhoids.

People who experience autonomic dysreflexia during digital stimulation may use topical anesthetic medications like Lidocaine (Xylocaine) applied to their finger to numb the nerve endings during digital stimulation. There is moderate evidence that Lidocaine helps to reduce the symptoms of autonomic dysreflexia during digital stimulation.

Refer to our article on Autonomic Dysreflexia for more information! 

People with flaccid bowel do not have bowel reflexes, so digital stimulation is not effective. Instead, the stool needs to be removed manually. This is called manual evacuation, digital disimpaction, or a rectal clear. This technique involves the use of a gloved and lubricated finger, which is inserted into the anus and used to remove stool. It may be done in conjunction with use of a lubricating suppository.

There is limited evidence that manual evacuation helps to reduce the number of bowel accidents, and it is unclear whether it helps to reduce time spent on bowel care.

Abdominal massage is a technique where a person massages the abdomen by stroking or kneading the lower torso in a clockwise motion to increase movement within the colon. However, research results on whether abdominal massage is effective for helping with bowel care after SCI have been conflicting. Use caution when using abdominal massage after a recent surgery or if you have an abdominal stoma.